The fall open enrollment period for Medicare Advantage (MA) plans is now underway, and this year marks two milestones demonstrating the ongoing integration between MA and senior living.
With the start of the enrollment period on Oct. 15, a group of senior living providers known as the Perennial Consortium began to enroll the first beneficiaries in Medicare Advantage plans that they own in Colorado and Ohio.
While there is widespread agreement that Medicare Advantage could play an important role in shaping senior living in the years ahead, and certain providers already have made moves into the MA space, the Perennial Consortium has gained particular attention within the industry. Members of the Perennial Consortium are betting that by coming together to own plans — rather than partnering with existing insurers — senior living providers can maximize the upside of MA while gaining more clout within the health care continuum.
“It’s been exciting; we have hundreds of people who have already expressed interest,” Lynne Katzmann, CEO of Juniper Communities and a driving force behind the Perennial Consortium, told Senior Housing News.
In another development, two new Medicare Advantage plans are being rolled out in the Twin Cities; these plans will be exclusively available to residents of 160 senior living and long-term care communities operated by 22 providers in that metro area.
These new plans from nonprofit UCare involve a partnership with Genevive, a primary care and care coordination provider that is a joint venture of Allina Health System and senior living organization Presbyterian Homes & Services.
The UCare plans further cement the Minneapolis/St. Paul area as a hotbed for Medicare Advantage in senior living. Presbyterian Homes and nine other providers are also involved in a separate Medicare Advantage program that began in 2020, with Genevive and the health insurance company Medica.
Covid-19 is creating an unusual environment for marketing these new plans and enrolling members, but leaders with the Perennial Consortium, UCare and Genevive all believe that the pandemic will make MA coordinated care models even more attractive to consumers and beneficial to senior living provider companies.
The Perennial Consortium came together about two years ago, and initially involved three senior living operators: Bloomfield, New Jersey-based Juniper; Englewood, Colorado-based Christian Living Communities (CLC); and Columbus, Ohio-based Ohio Living. The effort also includes AllyAlign, a managed services partner and risk management company. Since its inception, additional provider groups have also joined the consortium, including McGregor, Graceworks, Jennings and Covenant Health.
Being able to tailor MA plans to the resident population in senior housing and care is fundamental to the value proposition put forward by the Perennial Consortium. The idea is that by having the right mix of benefits and managing them appropriately, the plan owners can drive profitability, while older adults on the plans will thrive because more of their needs are being met.
“Our job is to figure out what people need, and because we are the ones putting together the plan, we can frame it in a way to meet our residents’ needs better,” Katzmann said. “It’s supporting our family, if you will.”
While every MA plan is required to offer certain core benefits, one way that plans distinguish themselves is through their supplemental benefits. Defining the benefits for Perennial’s MA plans was a complex undertaking in part because the senior living providers that are involved offer services across the continuum, including independent living, assisted living, skilled nursing and memory care.
“Because they are at different levels of the continuum, they have different desires for benefits,” Katzmann said, referring to senior living residents.
The consortium is bringing four different plans to market, with two in Ohio and two in Colorado. Some of the plans are classified as institutional special needs plans (ISNPs) and some are chronic care special needs plans (CSNPs). Older adults generally qualify for an ISNP if they need an institutional level of care, while they qualify for a CSNP if they have certain chronic health conditions such as diabetes or congestive heart failure.
The supplemental benefits vary depending on state and type of plan. Even within a given plan, there can be variation in benefits among members. The CSNP plan in Colorado features a “cafeteria option” in which enrollees can opt for one benefit or another, depending on their needs and goals.
Senior living providers’ rising interest in Medicare Advantage is due, in part, to the new benefits that plans were allowed to offer thanks to legislative and policy changes. For example, the Centers for Medicare & Medicaid Services (CMS) in 2018 allowed MA plans to begin covering “daily maintenance” types of care in older adults’ homes. Other policies have opened up further options for designing benefits to meet the needs of people with chronic conditions.
Large Medicare Advantage insurers such as Humana have utilized these new flexibilities in creative ways to shift the locus of care to people’s homes, Katzmann noted. But the Perennial Consortium had to be judicious about which of these new supplemental benefits to include in its plans, as many of the new options make more sense for seniors who are not living in congregate settings.
For example, some large insurers are now offering MA benefits covering food delivery, transportation and home improvements to support aging-in-place. But, residents of senior living communities are already on dining programs, have access to transportation, and are living in environments designed for their needs.
By limiting their plans to benefits that they believe will be more appealing to senior living residents, the Perennial Consortium is able to reduce cost sharing and premiums, Katzmann said. Monthly premiums are listed at around $30 to $35 for both the Ohio and Colorado plans, with annual deductibles around $445. Coinsurance and copayment rates vary by plan.
One important benefit across all the plans involves care coordination.
“We have a highly personalized plan, with essentially your own concierge who coordinates your benefits, serves as your coach, and is the one who connects you with providers and makes sure the whole process is smooth,” Katzmann said.
She emphasized that is not a supplemental but a basic benefit. This is “huge” for providers like Juniper insofar as it creates an MA reimbursement stream for services that the company already offers through its Connect4Life model, essentially “institutionalizing” the medical concierge and care coordination.
Covid-19 has required more virtual marketing to spread awareness about the Perennial Consortium plans, but each senior living community does have a designated “champion.” These champions are leveraging a variety of channels, from radio shows and videos to brochures and banners. Only after someone expresses interest is a sales agent involved in the process, and the agent is employed by AllyAlign, not the senior living providers.
Of course, plans need to attract a critical mass of enrollees to be financially successful and sustainable, and that number is between 350 people and 500 people at a minimum, according to Katzmann. She anticipates more than double that number in Ohio and expects to surpass those thresholds in Colorado as well.
“Optimally, every plan should have at least 1,000 enrolled after the first couple of years,” she said. “Many of the SNPs out there right now are less than that and profitable.”
Indeed, there are other MA special needs plans owned by senior housing and care providers, which have provided models of success and failure. But ISNPs most typically have been organized around the needs of skilled nursing residents rather than those in assisted living. And the Perennial Consortium is launching its plans at a time when senior living providers have more options than ever before in terms of how to work with existing MA insurers, in a variety of financial and care models. Some skeptics of the Perennial Consortium approach argue that senior living providers will be better off sticking to the business they know best, which is providing housing and care, not insurance. They point to partnerships through which senior living providers can bring MA-reimbursed primary care on-site, without exposing operators to the challenges that go along with being in the insurance business.
But Katzmann and other Perennial Consortium leaders are outspoken about why they believe that their approach — owning plans outright rather than partnering with large insurance companies — is the best path forward. Plan ownership not only guarantees that benefit packages are optimized for senior living residents, but ensures that senior living operators can glean the financial upside from providing well-managed, coordinated care, through fair payment rates and gainshare opportunities. With their plans now coming to market, this argument is one important step closer to being tested.
“What makes our plan different is that it integrates (not just overlays) providers with community services which makes what we do more effective, more convenient and less costly,” Katzmann said.
New options in Minnesota
The Minneapolis/St. Paul area has been a hub of senior living activity for years, as assisted living penetration rates have soared and providers have brought innovative models such as cooperative housing to market. Now, providers and insurers in the Twin Cities are collaborating to bring more Medicare Advantage products into the senior living space.
UCare and Genevive announced that they collaborated to create two new MA plans that are exclusively available to qualified residents of 160 communities and facilities operated by 22 participating providers, including Presbyterian Homes & Services, Ecumen, Cassia and Walker Methodist.
These plans are not owned by the providers but are wholly owned by UCare, which is a nonprofit that serves about 500,000 members in plans throughout Minnesota and western Wisconsin.
The new plans were designed to meet the needs of senior housing and care residents, and Genevive — which is partly owned by Presbyterian Homes & Services and already provides services in about 100 senior living communities — played an active role in creating the benefits packages, Genevive CEO Amanda Tufano told SHN. In addition to the core medical and pharmacy benefits, supplemental benefits include vision, hearing, dental, transportation, an allowance that can be spent on over-the-counter pharmacy products, and a fall prevention kit.
“We were very, very involved in building the model of care,” Genevive CEO Amanda Tufano told SHN. “We’ve had a really busy 10 to 12 months here to try to launch this, and it’s been a really close partnership every step of the way.”
Genevive is a delegated provider for primary care and care coordination services, meaning the organization’s physicians, nurse practitioners and clinical nurse coordinators work with beneficiaries to create individualized plans, answer questions and facilitate care pathways.
UCare’s financial relationship with Genevive is a “value-driven” model with expectations built in for meeting high quality markers, Tufano said.
For UCare, creating these plans is part of a strategy to offer plans that are appropriate for people across different life stages.
“We’re looking at offering this as part of a continuum of products, so that we have something for people as they age or their health situation changes,” UCare Senior VP of Public Affairs and Chief Marketing Officer Ghita Worcester told SHN.
With this in mind, UCare expects that the plans will attract enrollees who are new to working with the organization, but also will gain membership from people who see one of the plans as a better fit than their current UCare plan.
Going forward, residents of some Twin Cities senior living communities will have the option to choose between one of these UCare plans and the MA plans offered by Medica, also in partnership with Genevive.
Having a greater variety of MA plans that are designed exclusively for their needs is a positive development for senior living residents, Tufano believes.
The Medica plans have already been in effect in 2020, and there have been “no big hiccups” in the partnership with Genevive, she said. But, there have been some lessons learned along the way.
“We are attempting to talk about something that no one’s ever heard of, so that has required us to put a lot more energy and effort into educating everyone we work with, on how this will work,” she said.
Insurance terminology and acronyms can be confusing and overwhelming, so simplifying the message is important, she believes. In rolling out plans this year, Genevive is working more closely with all stakeholders, has created more educational materials, and has dedicated “ambassadors” at sites. The ambassadors are not selling the plans but providing “foundational education” about what they offer and how Medicare Advantage works.
Covid-19 posed another challenge to Genevive, insofar as clinicians and other workers have had limited access to some senior living communities and campuses. The organization has leaned more on telemedicine, and luckily invested in technological infrastructure last year. Even when a pandemic is not in effect, having a close and constructive relationship with senior living operators is a crucial component to success, Tufano noted.
“We are really guests in their home — they invite us in, the facilities and residents,” she said.
Pandemic shows value of MA
The Covid-19 pandemic has highlighted that senior living communities are not only home to older adults, but are a part of the health care continuum. With current and prospective residents, and their loved ones, more concerned than ever about how senior living providers can support health and wellness, Medicare Advantage plans that are designed with residents’ needs in mind could become even more attractive.
Tufano thinks that being able to offer these MA plans could also help providers recover lost occupancy.
“I hope it brings confidence to those that are ready to take that next step and are just concerned that Covid is lasting so long, that we have a product and a solution and we have a provider team that can really manage your loved one in a way that you would want,” she said.
Juniper’s Katzmann makes a similar case for the Perennial plans.
“Ultimately, I think Covid has increased the need for people to have their services coordinated and brought to them,” she said. “I believe this type of MA plan does that.”